L12+13: Diuretics Flashcards
If you’re taking lithium, you can’t take…
thiazide diuretics reduce the clearance of lithium, causing toxicity
Reduced insulin secretion
can cause hyperglycemia in DM
thiazide diuretics
Hypocalcemia
Hypomagnesemia
Hyperuricemia
loop diuretics
Main side effect of vaptans
hypokalemia
Treats glaucoma
Acetazolamide
DOC for hypercalcemia
Furosemide (loop)
loops reduce reabsorption of Mg2+ and Ca2+ by reducing the K+ gradient
Loop which is most ototoxic
Ethacrynic Acid
Diuretic you can’t give to HF patient
osmotic diuretics
Drugs which produce hyperkalemia….
decrease the toxicity of digoxin
BUT hyperkalemia is toxic itself, causing peaked T waves
Hyperuricemia
thiazide diuretics (don't give for gout)
What’s the main adverse effect of CA inhibitors?
HYPERCHLOREMIC metabolic acidosis
Develops b/c the Na+ loss is in the form of NaHCO3 and not NaCl
Also: hypokalmia due to increases Na+/K+ exchange in the collecting duct causing more K+ excretion
Acetazolamide
Oral carbonic anhydrase inhibitor
Thiazide that is metabolized by the liver 50% and the kidneys 50%
Indapamide
Loop which ISN’T a sulfonamide
Ethacrynic Acid
why do aldosterone antagonists work for hirsutism in females but cause gynecomastia in males?
they also inhibit testosterone receptors
Brinzolamide
Topical carbonic anhydrase inhibitor (eye drops)
Central diabetes insipidus DOC
Desmopressin
Thiazide which does not increase plasma lipids
Indapamide
Hyperchloremic metabolic acidosis
carbonic anhydrase inhibitor
Desmopressin activates….
Activates V2»_space; V1 ADH receptors
DOC for HF
Furosemide (loop)
moves large volumes of water
Irreversible ototoxicity
loop diuretics
Irreversible ototoxicity
loops
best diuretics for low GFR
loops
Direct inhibitors of Na+ flux
Amiloride
Triamterene
aldosterone independent inhibition of Na+/K+ exchange
Generally, drugs which produce hypokalemia…
increase the toxicity of digoxin
K+ sparing diuretics (2)
Aldosterone antagonists
Direct inhibitors of Na+ flux
Hypokalemia —> hepatic coma in CIRRHOTIC patients
Thiazide diuretics are contraindicated in cirrhosis
Contain sulfa
Thiazides
Loops
Acetazolamide
Excessive administration of osmotic diuretics
extracellular volume expansion —> PULMONARY EDEMA IN HF (CONTRAINDICATED)
Don’t mix with aminoglycosides
loops (ototoxic)
Loops cause hypokalemic metabolic acidosis by
inducing K+ and H+ loss at the distal convoluted tubule
Demeclocycline used to treat
Central diabetes insipidus before vaptans
Thiazide with pronounced vasodilation
Indapamide
Dorzolamide
Topical carbonic anhydrase inhibitor (eye drops)
DOC for acute mountain sickness
Acetazolamide
Contraindicated in hepatic cirrhosis
Acetazolamide
due to decreased ammonia excretion
Thiazides
due to hypokalemia (can cause coma)
Osmotic diuretics are given…
IV only
what do carbonic anhydrase inhibitor cause loss of?
Na+ (leading to H2O loss)
Hyperaldosteronism DOC
spironolactone
The only thiazide diuretic which can work at low GFR
Metolazone
Hypokalemic metabolic acidosis
loop diuretics
thiazide diuretics
DOC pulmonary edema
Furosemide (loop)
relieves congestion by increasing systemic venous capacitance
Major beneficial effect of thiazides
Relaxation of smooth muscle cells —> VASODILATION
Diuretic whose effectiveness decreases after a few days
carbonic anhydrase inhibitor: Acetazolamide
increased prostaglandin synthesis…
Loops
Prostaglandins cause vasodilation